Leukemia Symptoms, Causes And Treatment

Leukemia is a group of malignant disorders that affects the blood and blood forming tissues such as lymphatic system, spleen and bone marrow. Basically, leukemia is the cancer of blood forming cells. There is excessive production of abnormal white blood cells in leukemia. The word Leukemia is derived from the Greek word leukos which means white and aima means blood.

Types

The leukemia can be broadly divided into four different types:

•  Acute myeloblastic leukaemia (AML)
•  Acute lymphoblastic leukaemia (ALL)
•  Chronic myelocytic leukaemia (CML)
•  Chronic lymphocytic leukemia (CLL)

The adjectives ‘myeloid’ and ‘lymphoid’ refer to the predominant cell involved. The suffix cytic and blastic refer to the mature and immature cells.

Causes

The exact cause of leukemia is still unknown. There are multiple factors contributing to leukemia.

1. Chemicals and cytotoxic drugs

Cytotoxic and immunosuppressive agents bear a small risk of causing acute leukemia. The combination of chemotherapeutic agents, alkylating agents, cyclophosphamide and radiotherapy presents the highest risk of causing leukemia. Exposures to paint, insecticides and solvents, the aromatic solvent benzene due to occupation are also responsible for the development of leukemia.

2. Genetic factors

Down's syndrome, constitutional trisomy of chromosome 21 is the factor that increases the risk of leukemia. Fanconi's anaemia and ataxia telangiectasia are the disorders that predispose to chromosomal breaks are also associated with acute leukaemia.

3. Hematological disorders

Hematological disorder increases the risk of developing leukaemia, particularly AML. These disorders include the myelodysplastic syndromes, the non-leukaemic myeloproliferative disorders, aplastic anaemia and paroxysmal nocturnal haemoglobinuria.

4. Viruses

Human T-cell lymphotropic virus also increases the risk of developing leukemia.

5. Radiation

There is an association between radiation exposure and leukemia. Patients who receive radiotherapy for hodgkin’s diseases, ankylosing spondylitis are at high risk for developing leukemia.

Symptoms

The most common sign and symptoms of leukemia are,

• Bleeding
• Anemia
• Infections
• Disseminated intravascular coagulation
• Headaches
• Vomiting
• Irritable behaviour
• Weight loss
• Night sweats
• Malaise
• Hyper metabolism
• Anorexia
• Hyperuricemia
• Generalized aches and pains
• Haemorrhage
• Unexplained fever
• Gingival hyperplasia
• Mouth sores
• Lymphadenopathy
• Sternal tenderness
• Hepatosplenomegaly

Treatment

There are different approaches for acute or chronic leukemia.

Acute Leukemia

The aim of treatment is to achieve complete remission of leukemia with the help of combination chemotherapy. Chemotherapeutic agents are given in three phases, induction, consolidation and maintenance. In induction phase, vincristine or vinblastine, cytarabine and 6-thioqinine is given. Intensive therapy is preferred in consolidation phase to eradicate any symptoms remaining. The ablation of bone marrow is an effective option for complete remission. After complete remission, recovery of normal haemeopoiesis begins. If the complete remission of leukemia is not achieved after two cycles of therapy, then an alternative treatment plan is used. Remission means the absence of all signs and symptoms of leukemia. Bone marrow transplantation is also preferred in severe cases. In acute myeloblastic leukaemia, the treatment plan consists of induction and consolidation therapy. Chemotherapeutic agents used in AML are more myelotoxic. So that the patient needs supportive care to survive these periods. The combination of vincristine, prednisolone, anthracyclines and asparaginase are responsible for complete remission of acute lymphoblastic leukaemia (ALL). Eat a diet that is rich in proteins, fibers and fluids. Avoid infections, smoking, spicy foods and maintain oral hygiene. 2000-3000ml intake of fluids is an ideal option for leukemia.

Chronic leukemia

The main aim of treatment is to increase the survival rate and reduce symptoms by normalizing the white blood cells count. Hydroxycarbamide at a dose of 1.5–2 g/day was the first drug used in chronic myelocytic leukaemia. This drug keeps the WBCs level under control in just 1-2 weeks. The side effects of hydroxycarbamide are rashes and gut disturbances. The withdrawal of hydroxycarbamide causes an abrupt increase in WBCs count. Interferon is also an effective drug in controlling the symptoms of chronic myelocytic leukaemia. This drug helps in the recovery of normal haemeopoiesis. Interferon therapy improves the symptoms of patients in chronic phase. There is no cure for chronic lymphocytic leukemia. Alkylating agent chlorambucil is the most effective drug used in CLL. Lymphocyte count is reduced by taking corticosteroids without causing myelosupression. Purine analogues such as fludarabine are also preferred in the initial phase of CLL.

Frequently Asked Questions

What are the risk factors of leukemia?

Previous cancer treatment, smoking, family history and genetic disorder are the risk factors for leukemia.

What are the complications of leukemia?

Graft-versus-host disease is the major complication of leukemia.